1105H
Fig. 16.7 Tetracycline was administered over a prolonged period to this patient
who has cystic fibrosis. This has resulted in its incorporation into the mineral matrix
with marked discoloration⎯alternative antibiotics are now used. Recent
improvements in the management of people with cystic fibrosis have meant that an
increasing number are not maintained on long-term antibiotic prophylaxis.
16.5 CONVULSIVE DISORDERS
16.5.1 Febrile convulsions
Convulsions are common; about 5% of children have had one or more convulsions
and accurate diagnosis of the aetiology is very important. The vast majority of these
are febrile convulsions and are associated with illnesses that cause high fever late in
infancy such as otitis media. The seizures are usually tonic-clonic with loss of
consciousness followed by sustained muscle contractions. Respiration may be
impaired, which may lead to cyanosis. The teeth are often firmly clenched with
possible tongue and lip-biting. There may also be a loss of bladder and bowel control.
This tonic phase is followed by the clonic phase of intermittent muscular contraction.
The duration is always less than 15 min. These convulsions usually occur early in the
illness during the period of rapid temperature rise and may be the first indication that
the child is ill. It is most important to eliminate the possibility of central nervous
system infection; therefore examination of the cerebrospinal fluid is essential if there
is persistent drowsiness following the attack.
16.5.2 Epilepsy
It may be difficult to differentiate these simple febrile convulsions from epilepsy but
it is essential that this diagnosis is made as the therapy, prognosis, and implications
differ enormously. 1106HTable 16.8 gives a list of conditions that are commonly associated
with recurrent seizures. Epilepsy is not a disease in itself but a term applied to
recurrent seizures, either of unknown origin (idiopathic epilepsy) or due to congenital
or acquired brain lesions (secondary epilepsy). It affects about 0.5-2% of the
population. Medical management usually consists of long-term anticonvulsant drug
therapy. The choice of drug depends on the seizure type, but the dosage needs to
control the seizures with minimal side effects. New generation anti-epileptic drugs
have become available, for example, Lamotrigine, Gabapentin, Oxcarbazepine,
Tiagabine, and Topiramate but even these are not without problems, for example,
hyperexcitability, dizziness, depression, weight loss, and abdominal problems. The
most familiar anti-epileptic drugs are Sodium Valproate, Phenytion, and